Forums » Medical Education & CPD » Journal club » Journal Club for June 2010 Enhanced external counterpulsation is a regenerative therapy
Journal Club for June 2010 Enhanced external counterpulsation is a regenerative therapy
posted at 1/6/2010 11:02 PM BST
Moved from the Journal club forum
Presumptively egotistical, at least not coy, I selected my own article for Journal Club that explains how EECP improves angina and may be considered for other regenerative therapies. I also included a study that was similar (probably better conducted) that also demonstrated that progenitor cells were increased by enhanced external counterpulsation.
I have nothing to disclose and no relationships with the manufacturers of these devices
Enhanced external counterpulsation is a regenerative therapy
The Effects of External Counter Pulsation Therapy on Circulating ... Alon Barsheshet, Hanoch Hod, Michael Shechter, Orna Sharabani-Yosef, Eti Rosenthal, Israel Barbash, Shlomi Matezky, Reshef Tal, Ariel G Bentancur, Ben-Ami Sela, Arnon Nagler, Jonathan Leor: Cardiology 110, 160- 166 (2008)
Excerpts from my paper and comments
“Enhanced external counterpulsation (EECP) is used for the treatment of severe angina and heart failure in patients who are not candidates for revascularization. The clinical benefits of EECP extend well beyond the time period of any hemodynamic effects, but the cause of this prolonged effect is not understood.”
EECP is a device “consisting of an air compressor, computer module, treatment table and a set of three pneumatic cuffs applied to each lower extremity. Continuous electrocardiographic monitoring was used to time inflation and deflation of the cuffs. The cuffs were inflated sequentially from calf to thigh during diastole, applying 250-300 mmHg of external pressure and deflated at end-diastole.” The therapy consists of 35 one hour treatments. “The mystery of EECP therapy is the prolonged benefit after treatment.”
Progenitor cells were measured before and each week for four weeks during therapy and progenitor cells increased each week. “One possible explanation for the long-term benefit is that EECP is a regenerative therapy. Progenitor cells line the endothelium. The shear forces described above are forceful enough to dislodge these cells so they enter the circulation. These cells will find damaged endothelium, ischemic myocardium or apoptotic cells and will proliferate so the benefit extends well beyond the treatment period. The number of circulating stem cells has been correlated with vascular disease, age and prognosis. Thus increasing these circulating cells seems a reasonable target for therapy “
The mechanism of increased shear is reversal of flow at the endothelial border
The important outcome of this paper is that a device could increase circulating stem cell and this leads to a better outcome. A new concept of disease was presented in this paper and I would like to share this concept with those willing to read farther.
“Regenerative therapy is a new concept
Regenerative therapy is a new concept in the treatment of diseases. Historically, the heart was considered unable to regenerate, but recent studies have shown that cardiomyocytes can proliferate following ischemic events. It is known that senescent cells are replaced daily in all the organs of the body. How this process occurs and its failure in certain diseased states such as myocardial infarction, stoke, and degenerative states is not understood.
Model of regenerative therapy
Our proposed model of regeneration is based on a single progenitor cell that is a direct descendent of the original embryological cell formed after fertilization. The cells are propagated in the bone marrow and released into the general circulation where they nestle into the endothelium or organ niches (14). They randomly circulate until they detect and replace a senescent cell. The senescent cell during apoptosis has a shift in internal proteins that changes its polarity resulting in an electromagnetic attraction. The replacement cell then differentiates according to cell to cell information transfer at the level of the cellular membrane (15). If there is a failure of information transfer or a breakdown in the electromagnetic forces the default differentiation is a fibroblast. This regenerative model is really a model of regeneration and degeneration. Health is a state when regeneration is in balance with degeneration. Disease can occur if either regeneration or degeneration is out of balance.
Can this model explain during embryological development why there is a patent ductus and patent foramen to bypass the lungs? Can it explain pulmonary hypertension associated with VSD, ASD, cirrhosis?
What other diseases and therapies for those diseases can you imagine?